title: Reduction in anastomotic strictures using bioabsorbable circular staple line reinforcement in laparoscopic gastric bypass.
abstract: BACKGROUND
  Anastomotic stricture remains the most common complication after laparoscopic gastric bypass with a circular-stapled gastrojejunostomy. The present study examined the effect of the use of bioabsorbable circular staple line reinforcement on the incidence of gastrojejunostomy anastomotic strictures as a complication of laparoscopic Roux-en-Y gastric bypass.
  
  
  METHODS
  A retrospective review was performed of 851 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass with circular-stapled gastrojejunostomy. Gore SeamGuard bioabsorbable circular staple line reinforcement was used in 596 consecutive patients subsequent to 255 consecutive patients without anastomotic reinforcement. The incidence of anastomotic stricture was compared after mean follow-up periods of 19 and 22 months for the two groups.
  
  
  RESULTS
  Anastomotic stricture requiring intervention was identified in 28 patients (2.94%). Only four patients (.67%) in the SeamGuard group developed anastomotic stricture compared with 24 patients (9.41%) in the no SeamGuard group. The use of staple line reinforcement is consistent with a 94% risk reduction in stricture formation.
  
  
  CONCLUSIONS
  The results have shown that the use of bioabsorbable circular staple line reinforcement on gastrojejunal anastomoses in laparoscopic Roux-en-Y gastric bypass significantly reduces the incidence of anastomotic stricture. The standard use of the bioabsorbable reinforcement on circular staple line anastomoses could be a part of the solution to the most common complication of laparoscopic gastric bypass.
authors.affiliation: Department of Surgery, Greenville Hospital System University Medical Center, 2104 Woodruff Road, Greenville, SC 29607, USA. jdscott@ghs.org
authors.forename: John D
authors.initials: JD
authors.lastname: Scott
authors.forename: William S
authors.initials: WS
authors.lastname: Cobb
authors.forename: Alfredo M
authors.initials: AM
authors.lastname: Carbonell
authors.forename: Brannon
authors.initials: B
authors.lastname: Traxler
authors.forename: Eric S
authors.initials: ES
authors.lastname: Bour
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015897:Comorbidity; D003251:Constriction, Pathologic / Q000517:prevention & control; D004146:Dioxanes / Q000627:therapeutic use; D004867:Equipment Design; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000473:pathology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011100:Polyglycolic Acid / Q000627:therapeutic use; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult
chemical_list: D004146:Dioxanes; D011100:Polyglycolic Acid; C443643:trimethylene carbonate